North Carolina Personal and Home Care Aide State Training Grant (PHCAST)

1. North CarolinaPersonal and Home Care Aide State Training Grant(PHCAST) Curriculum Overview and Orientation to Phases I & II Grantee: NC Department of Health and Human Services PHCAST is funded by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA)

2. Welcome and Purpose Barbara Boyce

3. PHCAST Management Team Kathy Turner, RN, PHCAST Project Director, Division of Health Service Regulation Jan Moxley, PHCAST Grant Administrator, Division of Aging and Adult Services Donna White, RN, Elder Rights/In-Home Aide, Division of Aging and Adult Services Susan Harmuth, Senior Program Manager, NC Foundation for Advanced Health Programs Phyllis Daw, PHCAST Program Coordinator, NC Foundation for Advanced Health Programs Kathie Smith, RN, Associate Vice President of State Relations, Home & Community-Based Care, Association for Home and Hospice Care of NC Cherie Rosemond, Research Scientist, UNC Center for Health Promotion & Disease Prevention Tara Green-Royster, Program Manger, UNC Center for Health Promotion & Disease Prevention Jennifer Craft Morgan, Assistant Professor, Gerontology Institute, Georgia State University Margaret Roberton, Director, Continuing Ed-Training & Standards, NC Community College System Barbara Boyce, Assoc. VP, Continuing Ed & Workforce Initiatives, NC Community College System

4. Community College Pilot Sites Includes both pilot years Excludes Halifax CC & Cape Fear CC/Elder House

5. Overview of PHCAST Susan Harmuth

6. Reasons PHCAST Was Funded Nationally • Increasing demand for direct care workers • Personal Care Aides and Home Care Aides are the fastest growing occupations • Plus, Nurse Aides are in the top 11 jobs in terms of largest job growth • Trained, competent workers are essential to quality care • Create a “Gold Standard” for minimum training

7. Key Concepts of NC PHCAST • Builds on prior Direct Care Worker Initiatives • Creates 4-phased framework for training and competency to better prepare new and incumbent workers • Training Venues: • Community Colleges • High Schools

8. Overview of NC’s 4-Phase Approach • Phase I – Introduction to Direct Care Work • Phase II – Direct Care Basics (pre-Nurse Aide level) • Phase III – Nurse Aide I • Phase IV – Advanced NA training/competency • Home Care Nurse Aide • Geriatric Nurse Aide • Medication Aide • Option for in-service use across settings

10. Key Impacts • Better matching/redirecting of prospective workers to job • Competency based – certificate or credential at each phase • More consistent Pre-NA training • NA I training more realistic • Enhanced career paths, employability and responds to employer need (4-phase approach – specialties)

11. Key Impacts - Continued • New and incumbent workers can enter at various points • Expands state recognized career path options; supports workers; responds to employer need • Broad based support for model • Integration with other training & QI initiatives • Builds on prior direct care initiatives in NC

12. Key Impacts - Continued • More efficient use of NA I training programs • Employer recruitment of workers more focused • Reduces some barriers to training • High School students – job ready (NA I and Phase IV)

13. Sustainability • Framework makes sense for NC • Phase I, II, linked to HRD programs • State recognized job categories • Responds to employer need (employer participation) • Integration with other quality improvement efforts • Potential to add new modules in future

14. Questions

15. Human Resource Development and PHCAST Margaret Roberton

16. Human Resource Development Governance • SBCC Code – HRD Program Continuation Each college shall operate a Human Resources Development (HRD) program to provide assessment services, employability training, and career development counseling to unemployed and underemployed individuals. FTE shall be generated from HRD programs. Each college shall provide HRD instruction and support necessary for unemployed and dislocated workers to be served within the college service areas. • Vision and Mission Statement HRD is a dynamic and vital workforce development program with proven economic, social, and educational success. The purpose of the HRD program is to educate and train unemployed and underemployed individuals for success in the workplace.

17. HRD Program Goals • Provide program outreach and student recruitment activities to targeted populations • Assist students in accessing meaningful training and/or employment opportunities • Enhance and develop the student’s employability skills • Develop and promote the student’s ability to move towards economic self-sufficiency

18. Core Services Skill assessment services Employability skills training Career development counseling Target Groups Unemployed adults Underemployed adults Core Components Assessment of an individual’s assets and limitations Development of a positive self-concept employability skills communication skills problem-solving skills Awareness of the impact of Information Technology in the workplace 1D SBCCC 300.3 Program Classifications Human Resources Development

19. HRD Fee Waiver Guidelines • Eligibility Requirements • HRD courses are not free… Fees are waived • Waiver is based on the individual’s income • Unemployed • Underemployed* • Notification of pending lay-off

20. HRD Eligibility • For HRD purposes, underemployed is defined as individuals… • working and is eligible for the Federal Earned Income Tax Credit (FEIT); or • working and earning wages at or below two hundred percent (200%) of the federal poverty guidelines.

21. PHCAST Needs Aligned to HRD Core Services • Assessment • Ability to appropriately identify individuals prepared to enter healthcare fields • Introduce occupational requirements to maximize success of students progressing into Nurse Aide I • Introduce workplace realities of personal/home care environments vs. residential/institutional settings • Outline pathway alternatives for health care fields • Personal Home Care Aide • Recognized & standardized curriculum

22. Employability Skills Concepts contextualized for healthcare field Communication, listening skills, teamwork, and time/stress management Career Development Ability to problem solve independently Decision-making and management skills PHCAST Needs Aligned to HRD Core Services

23. Specific HRD PHCAST Courses • Phase I – Introduction to Direct Care Work (Focus on job readiness skills, literacy, numeracy, keyboarding, and realistic job previewing) • Career Exploration • Self-Assessment • General soft skill requirements • CPR (lay person)

24. Specific HRD PHCAST Courses • Phase II – Direct Care Basics (Focus on non-nurse aide personal care tasks and soft skill development; 3) expanded nurse aide (NA-1) skills) • Introduction to base skills • Introduction to functional concepts within role • Enhanced soft skills training • Career counseling

25. Questions

26. Importance of PHCASTto Employers and Personal Care Clients Donna White

27. Importance of PHCAST to Employers & Personal Care Clients • Growing need for Continuum of Care • Rising cost of care & shortage of trained workers • Greater efficiency in healthcare delivery (lowering cost while improving delivery) • Promote quality care for increasing numbers of older adults and persons with disabilities

28. Employer Quote • My PHCAST trained employees expressed joy in going to the classes. They were excited about what they were learning and they created a tremendous bond with each other. We had a special ceremony for them at our last meeting and they were given pins. Based on what I have heard from them, it was worth going through the class. They enjoyed it. I believe PHCAST will help with caregiver retention. Vice President/ Home Care Agency

29. Statistics and Projections • In the next 20 years the number of persons 65 and older will almost double from 1.3 million to 2.3 million • North Carolina is 10th nationally in size of total population, we are 9th in those 60 and older. • By 2025, 86 of the NC’s 100 counties are projected to have more people over age 60 than age 17 and under

30. Statistics and Projections • In 2025, one in four North Carolinians will be 60 and older • Over the next two decades, the 75-84 age group will be the fastest growing of those ages 65 and older • The number age 85 and older will grow fastest beginning in 2030,when the oldest of our 2.4 million baby boomers near their 85 birthday

31. Statistics and Projections • NC currently has more than 17,000 older adults with Alzheimer’s or other types of dementia most of whom are being cared for at home or by family and friends. By 2030, the total number is projected to rise to nearly 300,000 • For those age 75 and older, 13% live below the federal poverty level and 30% live at or between 100-199% of the FPL

32. Demographics • Status of North Carolinians 65 and older: • Living alone 29% • Veterans 22% • Have a disability 38% • Median household income 27% • Income below poverty level 10% ($10,778) • Income is between 100-199% of the federal poverty level 25%

33. Employer Quote • I saw a client today whose caregiver went through the program. After speaking with the client and his guardian, I understood that they are really impressed with the caregiver and the improvement they have seen. She is being very thorough, she is noticing different things in the home, and she is alerting the office. I think PHCAST is going to help aides improve the relationships and the care they are providing. The client was thrilled with the care.RN Clinical Supervisor/Home Care Agency

34. NC Home Care Licensure • 10A NCAC 13J allows for two levels of home care aide, limited and extensive • There are multiple funding sources that fund these two levels of care need

35. Limited Assistance • Limited Assistance: Care to a client who requires hands-on care involving guided maneuvering of limbs with eating, toileting, bathing, dressing, personal hygiene, self- monitoring of medications or other tasks assigned that require weight bearing assistance half the time or less during the activity

36. Extensive Assistance • Extensive Assistance: Client is totally dependent or requires weight-bearing support more than half the time while performing part of an activity, such as guiding or maneuvering of limbs, and meets one of the following criteria: • Requires extensive assistance in more than two activities of daily living (ADLs) or • Needs an in-home aide to perform at least one task at the nurse aide II level; or • Requires extensive assistance in more than one ADL and has a medical or cognitive impairment that requires total care more than 50% of the time

37. PHCAST Role • PHCAST Phase II prepares limited assistance aides for the workforce

38. Employer Quote • As a supervisor, I have noticed that PHCAST graduates are giving me more pertinent information. Nurse Supervisor/ Home Care Agency

39. Questions

40. Recruitment and Marketing of PHCAST Margaret Roberton

41. Recruitment / Marketing: Getting Their Attention • Program Outreach • External Agencies • Internal Resources • Community

42. Recruitment / Marketing: Getting Their Attention • Program Outreach • External Agencies • JobLink Career Centers • Division of Workforce Solutions (ESC) • Social Services • US Committee for Refugees and Immigrants • Shelters • National Guard/Family Employee Assistant Center • Community-based Organizations

43. Recruitment / Marketing: Getting Their Attention • Program Outreach • Internal Resources • HRD classes • Introduction to Healthcare Occupations • HRD Strategies for Success • CE Healthcare classes • Back-to-Work intake sessions • Basic Skills Plus

44. Recruitment / Marketing: Getting Their Attention • Program Outreach • Community • Flyers and brochures • College catalogues • College website • Social Media • Email • Past HRD students (Phase I and Phase II) • Current and Past NA I students (Phase IV) • Local home care facilities

45. Recruitment / Marketing: Challenges • Communication of value • Home care agencies • Benefit of contextualized training • Benefit of advanced standardized training (Phase IV) • Participants • Benefit of credential for hiring • Benefit of commitment to entire pathway • Program schedule/mix

46. Questions

47. Curriculum Availability PHCAST Phases I and II Kathie Smith

48. PHCAST Phases I and II • Phase I – Includes job readiness skills, literacy, numeracy, keyboarding, realistic job previewing • Phase II – Includes personal care tasks and soft skill development for non-nurse aide level • An aide not listed on the NC Nurse Aide Registry as a Nurse Aide I (CNA) but may provide personal care to client’s with limited assistance needs in Home Care and in other settings where a Nurse Aide I is not required

49. PHCAST Phases I and II • NC PHCAST addresses the following objectives: • Help prospective workers have an understanding of educational and training requirements for each long term care sector pathway • Provide a uniform pre-nurse aide training program through community colleges that covers essential soft-skills, basic home management and personal care skills (non-nurse aide level providing limited assistance to clients)

50. Phase I and II Curriculum • Curriculum must be followed as written but instructors may develop creative ways to disseminate the information, adding as needed, activities that are learner-centered focused • Student attendance requirements are up to the individual college; this includes how classroom information is mastered, with flexibility for making up absences as allowed by the college